Between December 2014 and 10 February 2015, 23 cases of wound botulism among people who had injected heroin were reported in Norway (8 confirmed cases) and Scotland (6 confirmed and 9 probable cases). All of the cases were reported to have involved heroin use and most involved the intramuscular injection of the drug. In all the Norwegian cases, the individuals had bought the drugs in the Oslo area. For all the UK cases, where information is available, the drugs were bought in, or sourced from, Glasgow.

The source of infection is thought to be contaminated heroin. The geographical distribution of the potentially contaminated heroin is unknown at this time; however, if the contaminated heroin is still in circulation, further cases may occur.

Whether there is a link, or not, between the outbreaks in the two countries is currently unknown. However, based on information currently available on the temporal and geographic clustering of cases, it is possible that the cases are connected through exposure to the same batch, or batches, of contaminated heroin.

The risk of additional cases occurring in other countries of the EU/EEA may depend on the stage in the heroin distribution chain where contamination took place. If contamination occurred at an early (wholesale) level of heroin distribution, new cases may occur in other countries. As Clostridium botulinum is not transmitted from person to person, the risk to the general population in relation to these cases is negligible.

Wound botulism in people who inject heroin in Norway and the United Kingdom

Norway : 8 cases (all confirmed)

Scotland: 15 cases (6 confirmed, 9 probable)

Total cases = 23 cases

Notes

(1) Botulism is a serious paralytic illness caused by toxins produced mainly by the anaerobic bacterium Clostridium botulinum. There are three forms of disease depending on the site of toxin production: food-borne (ingestion of pre-formed toxin), intestinal, and wound. Wound botulism occurs when spores get into an open wound and reproduce in an anaerobic environment. People who inject drugs are at risk of wound botulism as the organism enters at sites of injection.

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The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU’s decentralised agencies. Read more >>